More Fuel for the Drug-Eluting vs. Bare-Metal Stent Debate

Widespread DES use is not cost-effective after the costs of late stent thrombosis and extended clopidogrel therapy are added to existing analyses.

Drug-eluting stents (DES) have been associated with an increased incidence of late stent thrombosis, but the consequences of late stent thrombosis were not accounted for in prior cost-effectiveness analyses of DES. These investigators used data from the SIRIUS and TAXUS-IV trials, both of which evaluated the cost-effectiveness of DES compared with bare-metal stents, to analyze the effect of late stent thrombosis on the cost-effectiveness of DES in the U.S.

Assuming a late stent thrombosis incidence of 0.5% and a case fatality rate of 40%, the authors estimated an increase over the number of events originally reported in DES trials of two additional deaths and three additional MIs per 1000 DES recipients. Applying a cost of $20,000 per death …

Reviewing Author

Joel M. Gore, MD

Disclosures

Grant/Research SupportNIH–National Heart, Lung, and Blood Institute

Joel M. Gore, MD

Disclosures

Grant/Research SupportNIH–National Heart, Lung, and Blood Institute